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Welcome to the RUG n Roll Midwest & Great Lakes Regional User Group for Cerner Clients Milwaukee, Wisconsin April 30 – May 2, 2007.

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Presentation on theme: "Welcome to the RUG n Roll Midwest & Great Lakes Regional User Group for Cerner Clients Milwaukee, Wisconsin April 30 – May 2, 2007."— Presentation transcript:

1 Welcome to the RUG n Roll Midwest & Great Lakes Regional User Group for Cerner Clients Milwaukee, Wisconsin April 30 – May 2, 2007

2 Interdisciplinary Teaching Records using PowerPlan Functionality Lynn Germanson, RN, BSN Senior Business Application Analyst Clinical Documentation Team Aurora Health Care, Milwaukee, WI Lori Zareczny, RN, BSN Business Application Analyst Clinical Documentation Team Aurora Health Care, Milwaukee, WI

3 Objectives Describe the challenges of standardizing Teaching Record content across multiple disciplines and multiple facilities. Describe how Interdisciplinary Teaching Records have been interpreted by Aurora Health Care using Cerner PowerPlan functionality. Describe how Teaching Records have been built in the electronic medical record for Aurora Health Care facilities.

4 Who is Aurora Health Care? Private, non-profit, teaching organization: 684 employed physicians 3,200 physicians on staff 25,000 employees $2.6 billion annual revenue 0.5 million IP days/year 2.3 million OP visits/year 0.25 million ED visits/year 0.3 million Home Care visits/ year 5.6 million retail Rx/year Integrated Delivery Network 14 Hospitals ( beds) 120+ Outpatient Clinics 140+ Retail Pharmacies Long Term Care Home Health Services Hospice Services Laboratory Services One of the nations Most Wired hospitals in 2004, 2005 & 2006

5 Where is Aurora?

6 Diverse Hospital Mix 14 Hospitals –Range from beds –Include rural community hospitals and metropolitan acute care hospitals –Teaching facilities –Newly constructed and acquired facilities –Various levels of Computerization

7 Cerner Applications at Aurora Hospital Core systems implemented from Patient Access (Registration & Scheduling) PowerChart Orders, Results, Charges Radiology, Surgery, Emergency Dept Interfaces: Lab, Transcription, Dietary, Digital Imaging Advanced product implementations under way PowerChart Office in Clinics (>75% done) Pharmacy (100% done) Multidisciplinary Clinical Documentation & eMAR (90% done) PowerPlans & INet (14% done) Teaching Records (1 st site Go-Live Sept. 2007) Barcode Medication Administration (new) CPOE (7% done)

8 Teaching Record History...first there was paper, then there were... Online FORMS

9 Form Mimics Paper Physical Therapy/Occupational Therapy: Developed short list of common teaching topics Ambulatory Surgery Teaching Record: First area to capture teaching in Cerner Form developed to capture their specialized teaching Speech, Nutrition, Nursing... Other Disciplines... Requested their Own teaching topics STOP!

10 Ambulatory Surgery


12 PT Teaching Record

13 Form Format? PROs Interdisciplinary Pulls LCV, so can see what was taught previously Customized to list specific teaching materials given CONs Each Topic requires 7 DTAs Complex Event Set Hierarchy Required teaching not identifiable Unable to individualize General Topics - Comment/note at bottom of page to be more specific Maintenance nightmare Teaching Records needed (>150)

14 The PowerGrid?

15 Prenatal Care Coordination Home Visit Teaching



18 PowerGrid Format PROs Useful for areas seeing patient over extended period of time (several months) with focused topics Can select multiple topics in one entry Allows individualization (comments) LCV pulls previous teaching, allowing review in form CONs LCV pulls previous teaching, so resign others data each time Several topics identified in each visit Confusing to new care provider One packed row vs. several rows in order to provide details about response to each topic Inpatient build would be several forms with multiple sections because of variety of teaching topic groupers Unable to identify Required Components

19 The Challenge

20 ... Incorporate >150 paper teaching records x 14 site variations using different formats into something that will be... Interdisciplinary Individualized Address Barriers to Learning for each learning session Address components identified through evidence / regulatory standards Allow easy review of previous charting Standardized across a multi-hospital system

21 Teaching Records using PowerPlan Design System Interdisciplinary Groups met several times to decide: Diagnosis-based plans (CMS/Premier standards) Subcategories in each Diagnosis Teaching Plan Required components to meet set standards Grouper Headers for other topic categories Topic detail level What is recorded about each topic – readiness, who, what, how, when, result

22 Diagnosis-Based Teaching Plans

23 Congestive Heart Failure / CHF Community Acquired Pneumonia / CAP Total Joint Replacement / TJR Cardiac Surgery Acute Coronary Syndrome /AMI Cerebral Perfusion Alteration / CVA etc...

24 Conceptual Design - Subcategories in Diagnosis Teaching Plans

25 Subcategories in Diagnosis Teaching Plans Diagnosis –Disease Condition –Tests / Procedures Treatments –Therapy / Equipment –Treatment Medication Management Functional Skills –Safety –Skills –Assistive Devices Nutrition –Guidelines –Diet Wellness –Advance Directives –Smoking Discharge –Review Instructions –Home Monitoring –Community Resources / Home Care

26 Building Blocks Diagnosis-based Teaching Records Plans Composed of Subcategory Building Blocks Includes Groupers which exist independently for use without Diagnosis Teaching Plans Diagnosis-based Plans Subcategory Groupers Diagnosis Disease Condition Tests / Procedures Nutrition Guidelines Diet Discharge Review Instructions Home Monitoring Community Resources/ Home Care Medication Management Treatments Therapy / Equipment Treatment Wellness Advance Directives Smoking Functional Skills Safety Skills Assistive Devices

27 Using Cerner Functionality to Drive Teaching Record Format Plans Teaching Record category – lives after Discipline Plans TEACH prefix helps in Plan Search window Document In Plan Interventions not Goals Ready to Learn Initial or Reinforcement Who taught Method of instruction Evaluation of patient progress Progress to Teaching Completion

28 Search and Select Teaching Plan

29 The Plan of Care Homepage

30 CHF Diagnosis Specific

31 CHF Treatments

32 CHF Medication Management

33 CHF Functional Skills and Nutrition

34 CHF Wellness

35 CHF Discharge

36 CHF Discharge cont.

37 Customize the Plan and Initiate

38 Only Selected Interventions Show

39 Document in Plan

40 Quick Chart

41 Linking to Form


43 Note/Variance Details

44 Teaching Documentation Ready to Learn? Initial vs. Reinforcement? Who Taught? Format Info Presented Evaluation of Learning

45 Teaching Documentation

46 Any Questions ?

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